COVID-19 is a highly infectious disease caused by a new coronavirus.
Most people who acquire COVID-19 will experience only mild to moderate symptoms and recover without needing specialist treatment. However, some people suffer severe respiratory illness and infection can result in death. Older people and those with underlying medical conditions, such as cancer, chronic respiratory disease, cardiovascular disease or diabetes are more likely to have severe symptoms or to die as a result of infection, although deaths have also been observed among younger people and those with no known underlying health conditions.
Are people with HIV more vulnerable to coronavirus?
At present there is no evidence that people with HIV are more vulnerable to acquiring COVID-19 or more likely to suffer severe symptoms or death if they become infected. Data collected from Wuhan, the first territory to report large numbers of cases of COVID-19 including among people living with HIV, found no significant differences in the number of cases or severity of illness. As this is a new virus there remain gaps in our understanding of how coronavirus may affect people with compromised immune systems and medical bodies’ recommendations for people with HIV may differ around the world.
It is generally considered likely that people with HIV whose virus is not fully suppressed, or who have a low CD4 count, may be more vulnerable to severe outcomes if they have COVID-19. Such individuals should take extra precautions, such as self-isolation, to avoid infection.
- People with a CD4 count over 200, who are taking HIV treatment and have an undetectable viral load are considered at no greater risk than the general population. They should follow general advice to stay at home and maintain social distancing.
- People with a CD4 count below 200, or who are not taking HIV treatment, or who have a detectable viral load may be at higher risk of severe illness. Nonetheless, they should still follow the same general advice.
- People with a very low CD4 count below 50 or who have had an opportunistic illness in the last six months should follow the ‘shielding’ advice for the extremely vulnerable.
Although people with HIV who are on effective treatment should be at no greater risk than the general population, other characteristics or underlying conditions may increase the risk of severe illness. In Europe, people over fifty account for almost half of all those living with HIV and older age is associated with severe illness and mortality for those with coronavirus. Moreover, some cancers, hypertension, cardiovascular disease and diabetes are more common in people with HIV and these conditions are known to raise risk.
How can people with HIV protect their health during the pandemic?
The COVID-19 pandemic is putting all health systems under severe additional strain, with many routine health services being simplified, postponed or suspended. If you are taking HIV medicine it is important that this continues without interruption. If you need to be admitted to hospital as a result of COVID-19, you should inform your healthcare provider of any medication you are on. Some antiretrovirals are available in liquid formulations which may be easier to take.
Restrictions on movement can create additional challenges for treatment adherence. It is recommended that people with HIV should ensure that they have access to adequate supply of any HIV medications they are on, ideally enough to last at least four weeks. Patients who are isolated or whose movements are restricted should consider how they can contact their clinic or healthcare providers, potentially through an online or telemedicine service, if this is available.
Vaccinations recommended for people living with HIV should be kept up to date (especially against influenza and pneumococcal disease).
Maintaining social contacts, on the phone or online, is important for mental health and emotional support.
Can HIV drugs be used to treat or prevent COVID-19?
The HIV drugs lopinavir/ritonavir are being trialled as treatment for COVID-19 in several studies, however no benefit was found in the first study to report (Cao). There is no evidence that HIV drugs, whether taken as treatment or as prevention (PrEP or PEP) helps to prevent infection with coronavirus.
Other HIV antiretrovirals, including darunavir/cobicistat and TMC-310911, an investigational protease inhibitor previously developed by Janssen, are also being investigated.
Cao B, Wang Y, Wen D et al. A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. New England Journal of Medicine, March 2020